J Breast Cancer.  2016 Dec;19(4):402-409. 10.4048/jbc.2016.19.4.402.

Chemotherapy-Induced Left Ventricular Dysfunction in Patients with Breast Cancer

• Yoon HJ
• Kim KH
• Kim JY
• Park HJ
• Cho JY
• Hong YJ
• Park HW
• Kim JH
• Ahn Y
• Jeong MH
• Cho JG
• Park JC

• KMID: 2362926
• DOI: http://doi.org/10.4048/jbc.2016.19.4.402

Abstract

PURPOSE
As the numbers of cancer cases and survivors increase, the incidence and natural history of chemotherapy-induced cardiotoxicities in patients with breast cancer may also be expected to change. The present study aimed to investigate the incidence and predictors of chemotherapy-induced left ventricular dysfunction (LVD) in patients with breast cancer.
METHODS
From 2003 to 2010, 712 female patients with breast cancer (55.7±10.7 years) were enrolled and divided into the LVD group (n=82, 56.7±10.1 years) and the non-LVD group (n=630, 55.6±10.8 years). Baseline clinical and treatment-related variables were compared.
RESULTS
Chemotherapy-induced LVD developed in 82 cases (11.4%). Low body mass index (BMI), low triglyceride level, advanced cancer stage, and the use of doxorubicin, paclitaxel, trastuzumab, or radiotherapy were significant predictors of LVD in a univariate analysis. In a multivariate analysis, low BMI, advanced cancer stage, and the use of target therapy with trastuzumab were independent predictors of chemotherapy-induced LVD. Chemotherapy-induced LVD was recovered in 53 patients (64.6%), but left ventricular function was not recovered in 29 patients (35.4%).
CONCLUSION
Chemotherapy-induced LVD was not uncommon and did not reduce in many of our patients with breast cancer. Low BMI, advanced cancer stage, and the use of trastuzumab were independent predictors of chemotherapy-induced LVD in patients with breast cancer. The development of chemotherapy-induced LVD should be carefully monitored in patients with breast cancer who are receiving trastuzumab therapy, have poor nutritional status, and advanced cancer stage.

Keyword

Anthracyclines; Breast neoplasms; Cardiotoxicity; Paclitaxel; Trastuzumab

MeSH Terms

Anthracyclines
Body Mass Index
Breast Neoplasms*
Breast*
Cardiotoxicity
Doxorubicin
Female
Humans
Incidence
Multivariate Analysis
Natural History
Nutritional Status
Paclitaxel
Radiotherapy
Survivors
Trastuzumab
Triglycerides
Ventricular Dysfunction, Left*
Ventricular Function, Left
Anthracyclines
Doxorubicin
Paclitaxel
Trastuzumab

Figure

• 

  Figure 1 Baseline TNM staging of breast cancer. The percent of advanced T stage were significant higher in left ventricular dysfunction (LVD) group (A) than in no LVD group (B). The percent of advanced N stage were significant higher in LVD group (C) than in no LVD group (D). The percent of advanced M stage were significant higher in LVD group (E) than in no LVD group (F).

• 

  Figure 2 Left ventricular dysfunction (LVD)-free survival according to the body mass index (BMI) (A) and use of trastuzumab (B) on Kaplan-Meier curve analysis. (A) LVD-free survival rate was significant higher in patients with higher BMI than those with lower BMI. (B) LVD-free survival rate was significant higher in patients without expose to trastuzumab than those treated with trastuzumab.

• 

  Figure 3 Incidence and fate of left ventricular dysfunction (LVD) during follow-up period.

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